Offering Care for Older Americans
Medicare is a federal health insurance program that currently exists in the United States.
The Original Medicare Plan-
Is a fee-for-service plan. It covers many health care services and certain drugs. Those enrolled in Medicare may visit any doctor or hospital that accepts Medicare to receive Medicare benefits. To prove one’s enrollment in the Medicare program, patients are given red, white and blue Medicare cards.
Although Medicare covers many services and supplies, it does not cover all health care costs. Medicare does not cover costs such as coinsurance fees, co-payments, and deductibles. These costs are called “gaps” in the Medicare coverage. Additional health care plans are an option to help cover these gaps. Such plans are referred to as Medigap policies. Another additional plan option would be a Medicare Prescription Drug Plan that would aid in the patient’s payment for prescription drugs.
These and other plans options are discussed later in greater detail.
Medicare is a two-part plan:
-->helps to cover inpatient care in hospitals including critical access hospitals, and
skilled nursing facilities (that are not custodial or long-term care institutions)
-->also helps to cover hospice care and some home health care
-->helps cover doctor services and outpatient care
-->also covers some other medical services that Part A does not cover such as some of the services as physical and occupational therapists and some home health care
Medicare plan choices:
The Original Medicare Plan- discussed above
Medicare Advantage Plans- are plan options that are part of the Medicare program. In choosing one of these plans you get all your Medicare-covered health care through that plan. Services such as prescription drug coverage may be included your plan of choice. Medicare Advantage Plans include Medicare Health Maintenance (HMOs), Preferred Provider Organizations (PPO), Private Fee-for-Service-Plans, and Medicare Special Needs Plans.
Medigap (Supplemental Insurance) Policies- are sold by private insurance companies to help fill the “gaps” in Original Medicare plan coverage. If you choose to buy a Medigap policy and already have Medicare coverage, the two plans will work together to pay their shares of your health care costs. Medigap policies are standardized into choices A-L. Each has specific benefits outlined so that you can compare options easily. These plans must follow Federal and Stately laws designed to protect you as a buyer. Insurance companies choose which Medigap plans they wish to sell. You and your spouse must buy separate Medigap policies.
Medicare Prescription Drug Plans- “add coverage to the Original Medicare Plan, some Medicare Cost Plans, some Medicare Private-Fee-for-Service Plans and Medicare Medical Savings Account Plans.” Insurance companies and other private companies that have been approved by Medicare may offer these plans.
Employer or Union Coverage- may continue or switch over to provide coverage for you when you are 65 and retired. Strict rules and regulations must be followed for companies to offer group health care coverage.
For a comparison between Medicare and Medicaid CLICK HERE
To visit the official Medicare website CLICK HERE